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13 pages, 3618 KiB

Open AccessArticle

Comparative Analysis of the Visual, Refractive and Aberrometric Outcome with the Use of 2 Intraocular Refractive Segment Multifocal Lenses

by Bartłomiej Markuszewski, Adam Wylęgała, Nóra Szentmáry, Achim Langenbucher, Anna Markuszewska and Edward Wylęgała

J. Clin. Med. 2024, 13(1), 239; https://doi.org/10.3390/jcm13010239 - 31 Dec 2023

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Abstract

To demonstrate the results of ray tracing higher- and lower-order aberrations in pseudophakic eyes with rotationally asymmetrical segment multifocal lenses, total high- and low-order aberrations, measured by root mean square value (RMS), refraction, uncorrected distance and uncorrected near visual acuity (UCDVA and UCNVA), [...] Read more.

To demonstrate the results of ray tracing higher- and lower-order aberrations in pseudophakic eyes with rotationally asymmetrical segment multifocal lenses, total high- and low-order aberrations, measured by root mean square value (RMS), refraction, uncorrected distance and uncorrected near visual acuity (UCDVA and UCNVA), and tear break-up time, were measured at scotopic size in 42 eyes of patients implanted with bifocal refractive Mplus15/Mplus30 IOL with +1.5 dpt near addition (42 eyes of patients implanted with Mplus15)/+3.0 dpt near addition (91 eyes of patients implanted with Mplus30), and 107 eyes of control group. No significant differences were noticed between the examined groups concerning UCDVA, UCNVA, and tear break-up time (p < 0.001). Coma and total high-order aberrations were significantly higher for the Mplus30 lens in comparison to the Mplus15 lens and the control group (Coma, Trefoil p < 0.001, Secondary Astigmatism p = 0.002). The spherical aberrations were significantly higher in the lower-addition lens (p = 0.016) in comparison to the control group and to the higher-addition lens group (p < 0.001). Both intraocular lens models were successful at reaching refractive aim, good distance, and near function with the lower higher-order aberrations for the low-addition lens. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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16 pages, 2210 KiB

Open AccessArticle

Bootstrapping of Corneal Optical Coherence Tomography Data to Investigate Conic Fit Robustness

by Achim Langenbucher, Nóra Szentmáry, Alan Cayless, Lena Münninghoff, Adam Wylegala, Jascha Wendelstein and Peter Hoffmann

J. Clin. Med. 2023, 12(10), 3522; https://doi.org/10.3390/jcm12103522 - 17 May 2023

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Abstract

Background: Fitting of parametric model surfaces to corneal tomographic measurement data is required in order to extract characteristic surface parameters. The purpose of this study was to develop a method for evaluating the uncertainties in characteristic surface parameters using bootstrap techniques. Methods: We [...] Read more.

Background: Fitting of parametric model surfaces to corneal tomographic measurement data is required in order to extract characteristic surface parameters. The purpose of this study was to develop a method for evaluating the uncertainties in characteristic surface parameters using bootstrap techniques. Methods: We included 1684 measurements from a cataractous population performed with the tomographer Casia2. Both conoid and biconic surface models were fitted to the height data. The normalised fit error (height—reconstruction) was bootstrapped 100 times and added to the reconstructed height, extracting characteristic surface parameters (radii and asphericity for both cardinal meridians and axis of the flat meridian) for each bootstrap. The width of the 90% confidence interval of the 100 bootstraps was taken as uncertainty and quoted as a measure of the robustness of the surface fit. Results: As derived from bootstrapping, the mean uncertainty for the radii of curvature was 3 µm/7 µm for the conoid and 2.5 µm/3 µm for the biconic model for the corneal front/back surface, respectively. The corresponding uncertainties for the asphericity were 0.008/0.014 for the conoid and 0.001/0.001 for the biconic. The respective mean root mean squared fit error was systematically lower for the corneal front surface as compared to the back surface (1.4 µm/2.4 µm for the conoid and 1.4 µm/2.6 µm for the biconic). Conclusion: Bootstrapping techniques can be applied to extract uncertainties of characteristic model parameters and yield an estimate for robustness as an alternative to evaluating repeat measurements. Further studies are required to investigate whether bootstrap uncertainties accurately reproduce those from repeat measurement analysis. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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13 pages, 1011 KiB

Open AccessArticle

Application of an Interpretable Machine Learning for Estimating Severity of Graves’ Orbitopathy Based on Initial Finding

by Seunghyun Lee, Jaeyong Yu, Yuri Kim, Myungjin Kim and Helen Lew

J. Clin. Med. 2023, 12(7), 2640; https://doi.org/10.3390/jcm12072640 - 01 Apr 2023

Cited by 1 | Viewed by 1190

Abstract

(1) Background: We constructed scores for moderate-to-severe and muscle-predominant types of Graves’ orbitopathy (GO) risk prediction based on initial ophthalmic findings. (2) Methods: 400 patients diagnosed with GO and followed up at both endocrinology and ophthalmology clinics with at least 6 months of [...] Read more.

(1) Background: We constructed scores for moderate-to-severe and muscle-predominant types of Graves’ orbitopathy (GO) risk prediction based on initial ophthalmic findings. (2) Methods: 400 patients diagnosed with GO and followed up at both endocrinology and ophthalmology clinics with at least 6 months of follow-up. The Score for Moderate-to-Severe type of GO risk Prediction (SMSGOP) and the Score for Muscle-predominant type of GO risk Prediction (SMGOP) were constructed using the machine learning-based automatic clinical score generation algorithm. (3) Results: 55.3% were classified as mild type and 44.8% were classified as moderate-to-severe type. In the moderate-to-severe type group, 32.3% and 12.5% were classified as fat-predominant and muscle-predominant type, respectively. SMSGOP included age, central diplopia, thyroid stimulating immunoglobulin, modified NOSPECS classification, clinical activity score and ratio of the inferior rectus muscle cross-sectional area to total orbit in initial examination. SMGOP included age, central diplopia, amount of eye deviation, serum FT4 level and the interval between diagnosis of GD and GO in initial examination. Scores ≥46 and ≥49 had predictive value, respectively. (4) Conclusions: This is the first study to analyze factors in initial findings that can predict the severity of GO and to construct scores for risk prediction for Korean. We set the predictive scores using initial findings. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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13 pages, 2748 KiB

Open AccessArticle

Corneal Optical Densitometry in the Evaluation of 2-Year Graft Function Following Endothelial Keratoplasty

by Ilona Piotrowiak-Słupska, Bartłomiej J. Kałużny and Grażyna Malukiewicz

J. Clin. Med. 2023, 12(4), 1552; https://doi.org/10.3390/jcm12041552 - 16 Feb 2023

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Abstract

This study aimed to assess clinical application of the Scheimpflug corneal tomography for objective evaluation of corneal optical density in eyes undergoing Descemet’s stripping endothelial keratoplasty (DSEK). In this prospective study, 39 pseudophakic eyes with bullous keratopathy were enrolled. All eyes underwent primary [...] Read more.

This study aimed to assess clinical application of the Scheimpflug corneal tomography for objective evaluation of corneal optical density in eyes undergoing Descemet’s stripping endothelial keratoplasty (DSEK). In this prospective study, 39 pseudophakic eyes with bullous keratopathy were enrolled. All eyes underwent primary DSEK. Ophthalmic examination included best corrected visual acuity (BCVA) measurement, biomicroscopy, Scheimpflug tomography, pachymetry, and endothelial cell count. All measurements were taken preoperatively and within a 2-year follow-up period. Gradual BCVA improvement was observed in all patients. After two years, the mean and median BCVA values were 0.18 logMAR. A decrease in central corneal thickness was noted only during the first 3 months postoperatively and was followed by a gradual increase. Corneal densitometry decreased constantly and most significantly in the first 3 months postoperatively. The consecutive decrease in endothelial cell count of the transplanted cornea was most significant during the first 6 months postoperatively. Six months postoperatively, the strongest correlation (Spearman’s r = −0.41) with BCVA was found for densitometry. This tendency was maintained throughout the entire follow-up period. Corneal densitometry is applicable for objective monitoring of early and late outcomes of endothelial keratoplasty, showing a higher correlation with visual acuity than pachymetry and endothelial cell density. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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15 pages, 2016 KiB

Open AccessArticle

Polygenic Risk Score Impact on Susceptibility to Age-Related Macular Degeneration in Polish Patients

by Anna Wąsowska, Sławomir Teper, Ewa Matczyńska, Przemysław Łyszkiewicz, Adam Sendecki, Anna Machalińska, Edward Wylęgała and Anna Boguszewska-Chachulska

J. Clin. Med. 2023, 12(1), 295; https://doi.org/10.3390/jcm12010295 - 30 Dec 2022

Cited by 3 | Viewed by 1561

Abstract

Age-related macular degeneration (AMD) is a common retina degenerative disease with a complex genetic and environmental background. This study aimed to determine the polygenic risk score (PRS) stratification between the AMD case and control patients. The PRS model was established on the targeted [...] Read more.

Age-related macular degeneration (AMD) is a common retina degenerative disease with a complex genetic and environmental background. This study aimed to determine the polygenic risk score (PRS) stratification between the AMD case and control patients. The PRS model was established on the targeted sequencing data of a cohort of 471 patients diagnosed with AMD and 167 healthy controls without symptoms of retinal degeneration. The highest predictive value to the target dataset was achieved for a 22-variant model with a p-value lower than threshold P_T = 0.0123. The median PRS for cases was higher by 1.1 than for control samples (95% CI: (−1.19; −0.85)). The patients in the highest quantile had a significantly higher relative risk of developing AMD than those in the lowest reference quantile (OR = 35.13, 95% CI: (7.9; 156.1), p < 0.001). The diagnostic ability was investigated using ROC analysis with AUC = 0.76 (95% CI: (0.72; 0.80)). The polygenic susceptibility to AMD may be the starting point to expand AMD diagnostics based on rare highly penetrant variants and investigate associations with disease progression and treatment response in Polish patients in future studies. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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7 pages, 242 KiB

Open AccessArticle

Clinical Efficacy, Tolerability and Safety of a New Multiple-Action Eyedrop in Subjects with Moderate to Severe Dry Eye

by Anna Maria Roszkowska, Leandro Inferrera, Rosaria Spinella, Elisa Imelde Postorino, Romana Gargano, Giovanni Wiliam Oliverio and Pasquale Aragona

J. Clin. Med. 2022, 11(23), 6975; https://doi.org/10.3390/jcm11236975 - 26 Nov 2022

Cited by 2 | Viewed by 1490

Abstract

Background: To assess the clinical efficacy, tolerability and safety of a new-generation ophthalmic solution containing cross-linked hyaluronic acid 0.15% trehalose 3%, liposomes 1% and sterylamine 0.25% (Trimix^® Off Health Italia, Firenze, Italy) (CXHAL) versus trehalose 3% (Thealoz^®, Thea Pharmaceuticals, Clermont-Ferrand, [...] Read more.

Background: To assess the clinical efficacy, tolerability and safety of a new-generation ophthalmic solution containing cross-linked hyaluronic acid 0.15% trehalose 3%, liposomes 1% and sterylamine 0.25% (Trimix^® Off Health Italia, Firenze, Italy) (CXHAL) versus trehalose 3% (Thealoz^®, Thea Pharmaceuticals, Clermont-Ferrand, France) (TRS) in subjects with moderate to severe dry eye disease (DED). Patients and methods: In this prospective, observational cohort study, 41 subjects with moderate to severe dry eye were enrolled and divided into two age- and sex-matched groups. Group 1 was treated with CXHA eye drops, and group 2 was treated with TRS eye drops four times daily for 2 months. All subjects were evaluated at baseline (V0) and at day 60 ± 3 (V1). The examination comprised Best Corrected Visual Acuity (BCVA) and Symptom Assessment in Dry Eye (SANDE). Tear osmolarity was evaluated using the TearLab Osmolarity System^®; Keratograph 5M (Oculus, Wetzlar, Germany) was performed to assess tear meniscus height (TMH), fluorescein tear break-up time (TBUT) and corneal and conjunctival fluorescein staining and meibography; furthermore, slit lamp evaluation was performed for eyelid erythema and edema, conjunctival chemosis and hyperemia and Meibomian gland secretion quality. Results: All patients completed the treatment. BCVA remained stable in both groups, and no adverse events were reported. After 2 months, both groups showed statistically significant improvements for SANDE (p = 0.001 and p = 0.012, respectively), TBUT values (p < 0.001 and p < 0.001, respectively) and staining (p = 0.004 and p = 0.001, respectively) as compared to baseline values. Group 1 showed a statistically significant improvement in SANDE frequency and tear osmolarity (p = 0.02 and p = 0.001, respectively), whereas chemosis was significantly reduced in group 2. The amount of TBUT improvement was statistically higher in group 1 compared to that in group 2 (p = 0.041). Conclusion: A new-generation multiple-action ophthalmic solution was safe and clinically effective in the treatment of moderate and severe dry eye, with significant improvements in the main ocular surface parameters. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

10 pages, 1257 KiB

Open AccessArticle

Real-Life Value of the Odysight^® Application in At-Home Screening for Exudative Recurrence of Macular Edema

by Gauthier Kielwasser, Laurent Kodjikian, Corinne Dot, Carole Burillon, Philippe Denis and Thibaud Mathis

J. Clin. Med. 2022, 11(17), 5010; https://doi.org/10.3390/jcm11175010 - 26 Aug 2022

Cited by 2 | Viewed by 1078

Abstract

Background: The aim of this study was to describe the value of the Odysight^® application in addition to a classical follow-up regimen in the detection of exudative recurrences in patients with macular edema. Methods: We conducted an observational, multicenter, retrospective study. The [...] Read more.

Background: The aim of this study was to describe the value of the Odysight^® application in addition to a classical follow-up regimen in the detection of exudative recurrences in patients with macular edema. Methods: We conducted an observational, multicenter, retrospective study. The Odysight^® application includes a visual acuity (VA) test that can lead to alerts in case of a drop of >5 VA letters on two successive tests. The efficacy of the alerts in detecting exudative recurrence was studied. Results: A total of 149 eyes of 123 patients were included. The sensitivity of alerts for the detection of recurrence was 30.8% (95% CI [17.6; 44.0]) and its specificity was 83.7% (95% CI [73.2; 94.3]. A better baseline VA was found to be significantly associated with a better retention of the application (OR = 0.05, 95% CI [0.002; 0.62]; p = 0.045). Of the 12/39 alerts that detected a recurrence, eight (20.5% of all alerts) resulted in the scheduling or advancement of an intravitreal injection. Conclusions: In the present study, the sensitivity and positive predictive value of the Odysight^® application seems low but its use in addition to the usual follow-up of the patient can detect, in certain cases, an early recurrence and thus allow an anticipated readjustment of the treatment. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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11 pages, 1079 KiB

Open AccessArticle

Correlation of Clinical Fibrillar Layer Detection and Corneal Thickness in Advanced Fuchs Endothelial Corneal Dystrophy

by Orlando Özer, Mert Mestanoglu, Antonia Howaldt, Thomas Clahsen, Petra Schiller, Sebastian Siebelmann, Niklas Reinking, Claus Cursiefen, Björn Bachmann and Mario Matthaei

J. Clin. Med. 2022, 11(10), 2815; https://doi.org/10.3390/jcm11102815 - 17 May 2022

Cited by 1 | Viewed by 1465

Abstract

Central subendothelial geographic deposits are formed as a fibrillar layer (FL) in advanced Fuchs endothelial corneal dystrophy (FECD). Previous studies demonstrated a significant decrease in corneal endothelial cell (CEC) density and an increase in focal corneal backscatter in the FL area. The present [...] Read more.

Central subendothelial geographic deposits are formed as a fibrillar layer (FL) in advanced Fuchs endothelial corneal dystrophy (FECD). Previous studies demonstrated a significant decrease in corneal endothelial cell (CEC) density and an increase in focal corneal backscatter in the FL area. The present study investigated the association of the FL with edema formation and its localization. Patients (n = 96) presenting for Descemet membrane endothelial keratoplasty (DMEK) for advanced FECD were included. Slit-lamp biomicroscopy with FECD grading was followed by Scheimpflug imaging with en face backscatter analysis and pachymetric analysis. FL dimensions were measured, and correlation with pachymetric values was performed. An FL was detected in 74% of all eyes (n = 71). Pachymetric values in FL-positive versus FL-negative eyes were for corneal thickness at the apex (ACT) 614 ± 52 µm and 575 ± 46 µm (p = 0.001), for peripheral corneal thickness at 1 mm (PCT_1mm) 616 ± 50 µm and 580 ± 44 µm (p = 0.002), for PCT_2mm 625 ± 48 µm and 599 ± 41 µm (p = 0.017), for PCT_3mm 651 ± 46 µm and 635 ± 40 µm (p = 0.128) and for PCT_4mm 695 ± 52 µm and 686 ± 43 µm (p = 0.435), respectively. Correlation analysis indicated a weak correlation for the FL maximum vertical caliper diameter with ACT and PCT_1mm values but no further relevant correlations. In FL-positive eyes, increased focal corneal backscatter and increased corneal thickness showed primarily central and inferotemporal localization. In conclusion, Scheimpflug imaging shows an association of the FL with increased corneal thickness in advanced FECD and shows localization of the FL and increased corneal thickness in the central and inferotemporal region. This may provide important information for progression assessment and therapeutic decision making in FECD patients in the future. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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8 pages, 1220 KiB

Open AccessArticle

The Feasibility of Surface Electromyography in Monitoring Orbicularis Oculi Recovery after Anterior Approach Levator Aponeurosis Advancement

by Larysa Krajewska-Węglewicz, Marta Banach, Ewa Filipiak, Joanna Sempińska-Szewczyk, Piotr Skopiński and Małgorzata Dorobek

J. Clin. Med. 2022, 11(3), 731; https://doi.org/10.3390/jcm11030731 - 29 Jan 2022

Cited by 2 | Viewed by 2737

Abstract

Introduction: In this article, we propose a new application for eyelid surface electromyography (sEMG). By placing the electrode in the mid-pretarsal area of the upper eyelid, one can easily perform a fast examination and achieve repeatable results. We believe that this technique may [...] Read more.

Introduction: In this article, we propose a new application for eyelid surface electromyography (sEMG). By placing the electrode in the mid-pretarsal area of the upper eyelid, one can easily perform a fast examination and achieve repeatable results. We believe that this technique may increase the feasibility of eyelid sEMG in clinical practice. Methods: 126 sEMG examinations of the upper eyelid were performed by using the above-described method. Thirty-nine controls and 29 ptotic patients were enrolled. The controls underwent one measurement while the ptotic patients were employed for four sessions: Before anterior approach levator aponeurosis advancement (LAA), 2 weeks, 3 months, and more than 6 months after surgery. The relaxation and maximal contraction of the orbicularis oculi muscle (OOM) using root mean square (RMS) values were measured. Results: The results showed a statistically significant decrease in RMS values of the maximal contraction of the OOM 2 weeks after surgery (p < 0.05) and 3 months after surgery (p = 0.03). Six months postoperatively, there were no statistically significant differences in OOM activity compared to preoperative values (p = 0.2). Conclusions: Eyelid sEMG may be a useful diagnostic tool in post-operative OOM recovery monitoring. sEMG parameters of the maximal contraction of the OOM normalize within 6 months after anterior approach LAA. Electrode placement in the mid-pretarsal area of the upper eyelid offers several advantages and therefore may enhance the feasibility of sEMG in clinical practice. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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16 pages, 2410 KiB

Open AccessArticle

Novel Method of Measuring Corneal Viscoelasticity Using the Corvis ST Tonometer

by Agnieszka Boszczyk, Henryk Kasprzak and Joanna Przeździecka-Dołyk

J. Clin. Med. 2022, 11(1), 261; https://doi.org/10.3390/jcm11010261 - 04 Jan 2022

Cited by 4 | Viewed by 1852

Abstract

Background: The process of rapid propagation of the corneal deformation in air puff tonometer depends not only on intraocular pressure, but also on the biomechanical properties of the cornea and anterior eye. One of the biomechanical properties of the cornea is viscoelasticity, which [...] Read more.

Background: The process of rapid propagation of the corneal deformation in air puff tonometer depends not only on intraocular pressure, but also on the biomechanical properties of the cornea and anterior eye. One of the biomechanical properties of the cornea is viscoelasticity, which is the most visible in its high-speed deformations. It seems reasonable to link the corneal viscoelasticity parameter to two moments of the highest speed of corneal deformations, when the cornea buckles. The aim of this work is to present a method of determining the time and place of occurrence of corneal buckling, examine spatial and temporal dependencies between two corneal applanations and bucklings in the Corvis ST tonometer, and correlate these dependencies with corneal viscoelastic properties. Methods: Images of the horizontal cross section of the Corvis ST deformed cornea from the air puff tonometer Corvis ST were used. 14 volunteers participated in the study, each of them had one eye measured eight times. Mutual changes in the profile slopes of the deformed corneas were numerically determined. They describe pure corneal deformation, eliminating the influence of rotation, and displacement of the entire eyeball. For each point in the central area of the corneal profile, the maximum velocities of mutual slope changes accompanying the applanations were estimated. The times of their occurrence were adopted as buckling times. Results: The propagation of buckling along the corneal profile is presented, as well as the repeatability and mutual correlations between the buckling parameters and intraocular pressure. Based on the relationship between them, a new parameter describing corneal hysteresis: Corvis Viscoelasticity (CVE) is introduced. It is characterized by high repeatability: ICC = 0.82 (0.69–0.93 CI) and low and insignificant correlation with intraocular pressure: r = 0.25 (p-value = 0.38). Conclusion: The results show for the first time how to measure the corneal buckling and viscoelastic effects with Corvis ST. CVE is a new proposed biomechanical parameter related to the viscoelastic properties of the cornea, which has high repeatability for the examined subject. The distribution of its values is planned to be tested on different groups of patients in order to investigate its clinical applicability. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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17 pages, 1930 KiB

Open AccessArticle

Short-Time Changes of Intraocular Pressure and Biomechanics of the Anterior Segment of the Eye during Water Drinking Test in Patients with XEN GelStent

by Joanna Przeździecka-Dołyk, Ewa Wałek, Agnieszka Jóźwik, Iwona Helemejko, Magdalena Asejczyk-Widlicka and Marta Misiuk-Hojło

J. Clin. Med. 2022, 11(1), 175; https://doi.org/10.3390/jcm11010175 - 29 Dec 2021

Cited by 2 | Viewed by 1530

Abstract

Purpose: Little is known about short-term changes in intraocular pressure (IOP) following minimally invasive glaucoma surgeries, such as post-XEN GelStent implantation. Although the importance of corneal biomechanics in glaucoma diagnostics has been reported, little work has been conducted on postoperative description of changes [...] Read more.

Purpose: Little is known about short-term changes in intraocular pressure (IOP) following minimally invasive glaucoma surgeries, such as post-XEN GelStent implantation. Although the importance of corneal biomechanics in glaucoma diagnostics has been reported, little work has been conducted on postoperative description of changes when the structure of the anterior segment is altered. The aim of presented study was to evaluate the changes in the biomechanical parameters of the anterior segment of the post-XEN GelStent implantation eyes. Patients and Methods: This investigator-initiated, open-label, prospective, single-center study recruited patients. Patients with primary open-angle glaucoma (POAG) after XEN GelStent implantation versus matched POAG controls (considered as control group/CG) treated pharmacologically were screened. Water loading was conducted using 10 mL of water per kilogram of body weight for ≤5 min. Goldmann applanation tonometry (GAT), corneal hysteresis (CH), and corneal resistance factor (CRF) were performed before water loading and after every 15 min up to 1 h. Results: The water drinking test (WDT) was positive in 3.7% (1 out of 27) of patients in the post-XEN group compared with 22.7% (5 out of 22) of patients in the control group (CG; p < 0.05). Mean fluctuations in GAT during the WDT were higher in the CG group (3.6 ± 2.5 mmHg vs. 2.9 ± 1.3 mmHg, p < 0.001). CRF and CH changed significantly only in the post-XEN group. The mean peak of CH and CRF occurred at 15 and 30 min of the test in the post-XEN group (p = 0.001). Conclusion: WDT is important to assess the ability of compensation mechanisms to reduce fluctuations in IOP after water upload. The relationship between biomechanics of the anterior segment and glaucoma may have substantial impact on surgical outcome evaluation. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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8 pages, 1469 KiB

Open AccessArticle

Peripheral Retinal Degenerations and Idiopathic Epiretinal Membrane: Analysis with Ultra-Wide-Field Scanning Laser Ophthalmoscopy

by Klaudia Ulfik-Dembska, Sławomir Teper, Michał Dembski, Anna Nowińska and Edward Wylęgała

J. Clin. Med. 2021, 10(17), 3876; https://doi.org/10.3390/jcm10173876 - 28 Aug 2021

Cited by 5 | Viewed by 2139

Abstract

Background: The present study examined the relationships among retinal structure, peripheral retinal abnormalities, and epiretinal membrane (ERM) and explored the utility of ultra-wide-field laser scanning ophthalmoscopy in idiopathic ERM assessment. Methods: The study sample comprised 276 eyes of 276 patients. Ultra-wide field fundus [...] Read more.

Background: The present study examined the relationships among retinal structure, peripheral retinal abnormalities, and epiretinal membrane (ERM) and explored the utility of ultra-wide-field laser scanning ophthalmoscopy in idiopathic ERM assessment. Methods: The study sample comprised 276 eyes of 276 patients. Ultra-wide field fundus imaging was performed without mydriasis using Optos California. Each patient underwent a Goldmann three-mirror contact lens fundus examination. Results: Ultra-wide field laser scanning ophthalmoscopy revealed peripheral retinal degeneration in 84 (54.54%) eyes in the ERM and in 28 (22.95%) eyes in the control group. Goldmann three-mirror contact lens examination revealed peripheral retinal degeneration in 96 (62.33%) eyes in the ERM group and 42 (34.42%) eyes in the control group. Ultra-wide field ophthalmoscopy enabled the detection of nearly 87% of all peripheral retinal lesions in patients with ERM, but it cannot replace fundus examination with a Goldmann triple mirror or ophthalmoscopy with scleral indentation. Conclusions: In most patients, idiopathic ERM coexisted with changes in the peripheral retina. Some of these changes promote retinal detachment. Thus, surgeons should consider the risk of retinal tear during vitrectomy, which increases the scope of surgery and may adversely affect prognosis. Although ultra-wide field imaging is a valuable diagnostic method, it is not a substitute for Goldmann three-mirror contact lens fundus examination or ophthalmoscopy with scleral indentation. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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11 pages, 603 KiB

Open AccessArticle

How to Predict the Suitability for Corneal Donorship?

by Franziska Schön, Adrian Gericke, Julia Bing Bu, Melissa Apel, Alicia Poplawski, Alexander K. Schuster, Norbert Pfeiffer and Joanna Wasielica-Poslednik

J. Clin. Med. 2021, 10(15), 3426; https://doi.org/10.3390/jcm10153426 - 31 Jul 2021

Cited by 3 | Viewed by 1805

Abstract

Background: In Germany, more than one-third of donor corneas harvested are not suitable for transplantation. We evaluated the factors associated with the usability of donor corneas. Method: Data from 2032 consecutive donor corneas harvested at the Rhineland-Palatinate Eye Bank in Mainz, Germany, were [...] Read more.

Background: In Germany, more than one-third of donor corneas harvested are not suitable for transplantation. We evaluated the factors associated with the usability of donor corneas. Method: Data from 2032 consecutive donor corneas harvested at the Rhineland-Palatinate Eye Bank in Mainz, Germany, were retrospectively analyzed. Factors of interest were age, sex, lens status, cause of death, cardiopulmonary resuscitation (CPR), death-to-explantation-interval (DEI), and the influence of these factors on the proportion of discarded donor corneas. Factors associated with endothelial cell density (ECD) were analyzed in a linear regression mixed model. Results: Higher donor age, male gender, pseudophakic lens status, and longer DEI were associated with significantly reduced ECD. With respect to DEI, the estimated cell loss was 7 ± 2 cells/mm²/hour (p < 0.001). Age was associated with a lower ECD of 6 ± 2 cells/mm² per year (p = 0.001). Female ECD was 189 ± 44 cells/mm² higher than male ECD (p < 0.001). Pseudophakic eyes had 378 ± 42 cells/mm² less compared with phakic eyes (p < 0.001). Cause of death did not affect the ECD. Of note, 55% and 38% of corneas harvested on the second and third postmortem day, respectively, and 45% of corneas from donors older than 80 years were still suitable for transplantation. Conclusions: In the context of a growing need for donor corneas, we do not recommend limiting donor age and collection time to 24 h or excluding oncology donors, as is the practice in many countries. Therefore, we propose a mathematical model for better donor preselection. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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6 pages, 503 KiB

Open AccessArticle

A Retrospective Study of Herpetic Keratitis in Patients with Keratoconus after Crosslinking Surgery

by Ewa Wróblewska-Czajka, Anna Nowińska, Dariusz Dobrowolski, Dominika Szkodny and Edward Wylęgała

J. Clin. Med. 2021, 10(12), 2684; https://doi.org/10.3390/jcm10122684 - 18 Jun 2021

Cited by 3 | Viewed by 1616

Abstract

Background: The aim of this study was to perform a retrospective analysis of patients who underwent cross-linking for keratoconus, in the Department of Ophthalmology of the Medical University of Silesia in Katowice, between 2011 and 2020, regarding the occurrence of herpetic keratitis after [...] Read more.

Background: The aim of this study was to perform a retrospective analysis of patients who underwent cross-linking for keratoconus, in the Department of Ophthalmology of the Medical University of Silesia in Katowice, between 2011 and 2020, regarding the occurrence of herpetic keratitis after the procedure. Methods: We analyzed the medical history of 543 patients who underwent cross-linking surgery. Results: In the analyzed group, there were nine cases of herpetic keratitis (six men and three women), aged from 16 to 40 years (mean 26.2 years). The mean follow-up period was 49.3 months (16–82 months). The average time from surgery to the manifestation of the first symptoms of keratitis was 4.3 days (2–6 days). In two cases, iritis was observed, and in one of them, iritis was the first symptom. After systemic and topical administration of acyclovir, ulceration healed in all patients. Corneal healing time ranged from 10 days to 3 weeks (average 13.7 days). In one patient, a recurrence of the inflammation was observed after 8 months. Conclusion: Patients should be carefully observed in the early post-CXL period. Herpetic keratitis could be induced by CXL even in patients with no history of herpetic disease. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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13 pages, 2107 KiB

Open AccessArticle

Iris-Claw Intraocular Lens Implantation in Various Clinical Indications: A 4-Year Study

by Bogumiła Sędziak-Marcinek, Adam Wylęgała, Elżbieta Chełmecka, Mateusz Marcinek and Edward Wylęgała

J. Clin. Med. 2021, 10(6), 1199; https://doi.org/10.3390/jcm10061199 - 13 Mar 2021

Cited by 3 | Viewed by 4735

Abstract

An iris-claw intraocular lens (IOL) has been widely used as a secondary implant in aphakic patients. The study presents the results of implanting the anterior chamber iris-claw Artisan IOL in cases of where an appropriate posterior capsular support is lacking. The study included [...] Read more.

An iris-claw intraocular lens (IOL) has been widely used as a secondary implant in aphakic patients. The study presents the results of implanting the anterior chamber iris-claw Artisan IOL in cases of where an appropriate posterior capsular support is lacking. The study included 132 patients subjected to primary IOL implantation during complicated cataract surgery with damage to the posterior capsule (I), secondary implantation in aphakia (II), secondary implantation during penetrating keratoplasty (III), and secondary implantation during pars plana vitrectomy with luxated IOL extraction (IV). We analyzed the records of best-corrected visual acuity (BCVA), spherical equivalent (SE), intraocular pressure (IOP), and corneal endothelial cell count (cECC), taken before and 1, 2, 3, and 4 years after the surgery. BCVA depended on the time after IOL implantation and the primary indication. Four years post-surgery, the SE values were the lowest in group III. IOP was the same in all groups both before and after the surgery, but 4 years after the surgery IOP values in group IV were higher than in group III. The cECC decreased every year after the surgery in all groups, but four years after the IOL implantation, the lowest cECC values were observed in group IV. At the same time, all groups of patients showed improved BCVA, stable refraction, and a low percentage of postoperative complications. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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Review

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19 pages, 883 KiB

Open AccessReview

Corneal Sub-Basal Nerve Plexus in Non-Diabetic Small Fiber Polyneuropathies and the Diagnostic Role of In Vivo Corneal Confocal Microscopy

by Anna M. Roszkowska, Adam Wylęgała, Ludovica Gargiulo, Leandro Inferrera, Massimo Russo, Rita Mencucci, Bogusława Orzechowska-Wylęgała, Emanuela Aragona, Maura Mancini and Angelo Quartarone

J. Clin. Med. 2023, 12(2), 664; https://doi.org/10.3390/jcm12020664 - 13 Jan 2023

Cited by 3 | Viewed by 2097

Abstract

In vivo corneal confocal microscopy (IVCM) allows the immediate analysis of the corneal nerve quantity and morphology. This method became, an indispensable tool for the tropism examination, as it evaluates the small fiber plexus in the cornea. The IVCM provides us with direct [...] Read more.

In vivo corneal confocal microscopy (IVCM) allows the immediate analysis of the corneal nerve quantity and morphology. This method became, an indispensable tool for the tropism examination, as it evaluates the small fiber plexus in the cornea. The IVCM provides us with direct information on the health of the sub-basal nerve plexus and indirectly on the peripheral nerve status. It is an important tool used to investigate peripheral polyneuropathies. Small-fiber neuropathy (SFN) is a group of neurological disorders characterized by neuropathic pain symptoms and autonomic complaints due to the selective involvement of thinly myelinated Aδ-fibers and unmyelinated C-fibers. Accurate diagnosis of SFN is important as it provides a basis for etiological work-up and treatment decisions. The diagnosis of SFN is sometimes challenging as the clinical picture can be difficult to interpret and standard electromyography is normal. In cases of suspected SFN, measurement of intraepidermal nerve fiber density through a skin biopsy and/or analysis of quantitative sensory testing can enable diagnosis. The purpose of the present review is to summarize the current knowledge about corneal nerves in different SFN. Specifically, we explore the correlation between nerve density and morphology and type of SFN, disease duration, and follow-up. We will discuss the relationship between cataracts and refractive surgery and iatrogenic dry eye disease. Furthermore, these new paradigms in SFN present an opportunity for neurologists and clinical specialists in the diagnosis and monitoring the peripheral small fiber polyneuropathies. Full article

(This article belongs to the Special Issue Novel Medical Approach to Diagnostic and Therapeutic Algorithms in Ophthalmology)

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